Healthcare Provider Details

I. General information

NPI: 1164535712
Provider Name (Legal Business Name): ELIZABETH ANN GREENWOOD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 S LEWIS AVE STE 620
TULSA OK
74104-5712
US

IV. Provider business mailing address

PO BOX 14525
TULSA OK
74159-1525
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-4747
  • Fax: 918-392-4741
Mailing address:
  • Phone: 405-521-1969
  • Fax: 405-521-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number548
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: